Madagascar 1998

International staff: 11 National staff: 81 Children need legal protection The deteriorating socio-economic situation has seriously affected even the most basic health care. STD prevalence is very high and Madagascar is on the verge of an HIV/AIDS explosion. In Antananarivo, MSF works to improve access to health care for 4,000 street-children and children in institutional care, as well as around 400 women and children in a detention centre. In areas where children congregate, MSF has instituted 24-hour mobile paramedical teams identifying problems, providing health education and protection, and directing them towards a network of private doctors, treatment centres, pharmacies, a referral hospital and contact points in the main markets. Protection for abused children is strongly emphasised, as well as the application of a children's rights charter. The team ensures that children in institutional care or detained are monitored from a legal and social point of view. Awareness of street-children is being raised among institutions, ministries and municipal bodies. In 1998, MSF is also beginning to introduce psychological care into the programme. Another project encourages children to act more positively. MSF also works on behalf of homeless families in Antananarivo, providing emergency night-time care via mobile para-medical teams. A sanitation programme in Ankasina shantytown (pop. 36,000) was handed over to a local NGO in December 1997. MSF was providing latrines and access to adequate supplies of clean water as well as hygiene education and disease prevention. At national level, MSF is actively involved in developing strategies responding to public health problems such as malnutrition and the prevention and control of epidemics.